Buy viagra online no prescription

Side effects vary, but may include nausea, back pain or indigestion.

Complete your consultation questionnaire and we will recommend a treatment and dose suitable for you.

These are available for either discreet collection or delivery. Sildenafil 50mg vs 100mg How long does Viagra take to work?

Sildenafil vs Tadalafil What's the difference between Viagra Connect, Viagra and Sildenafil?

The blue pill Erectile dysfunction causes Erectile dysfunction young men What is Cialis Daily 5mg? Orders placed before 4pm Monday-Friday, and before 12pm on Sundays will be delivered the next working day. Order before 4pm Monday-Friday to collect in pharmacy the same day. Collect from one of our 1,500 LloydsPharmacy stores, including selected Sainsbury's.

Face coverings To ensure that everyone in our pharmacies feel safe and protected from COVID-19, we ask that our customers and patients follow the new mandatory government advice that face coverings are compulsory in shops and supermarkets from Friday 24th July in England. Bigger and Better: How Pfizer Redefined Erectile Dysfunction.

In the pursuit of profits, pharmaceutical companies are continuously looking to expand the market for their products. This article examines how Pfizer transformed Viagra from an effective product for erectile dysfunction (ED) due to medical problems, such as diabetes and spinal cord damage, into a drug that “normal” men can use to enhance their ability to achieve an erection and to maintain it (in a “harder” state) for a longer period of time. An important emerging issue in health care is the availability of medications to treat what until recently have been regarded as the natural

results

Thus, we now see treatments widely advertised for male pattern baldness and shyness.

Deviating even further, drug therapy is moving out of treating diseases to providing enhancements to what had hitherto been seen as normal functioning.

This evolution in the use of medications has introduced dilemmas and controversies about what are legitimate conditions and treatments for those concerned with prescription medications: is any deviation from normality fair game for treatment?

What about people who have nothing medically wrong with them, but just want to feel better? Who will pay for these therapies, and what are the implications for the way we use health-care resources? Medications that embody these controversies are generally referred to as lifestyle drugs and perhaps the best known of these is sildenafil citrate (Viagra) This article will examine the strategies used by Pfizer, the maker of Viagra, to ensure that the drug was seen as legitimate therapy for almost any man. Pfizer took steps to make sure that Viagra was not relegated to a niche role of just treating men who had ED due to organic causes, such as diabetes or prostate surgery.

There is no doubt that Viagra is an effective and quite safe drug in treating ED secondary to these causes, although a systematic review of the evidence found that the drug probably only results in successful intercourse 50%–60% of the time [ 1]. Had Viagra been confined to use only in cases of ED secondary to organic causes, the drug would probably have been a modest success for Pfizer. In order to grow the market, Pfizer had to make Viagra the treatment of choice for a much wider population of men. The perceived prevalence of ED needed to be expanded.

The impression had to be created that ED was of significant concern to many, perhaps even most, men or at least those over 40 years of age. The criterion of success for treating ED had to be redefined.

And finally, Viagra had to be seen as an important treatment option for men with any degree of ED, including rare or transitory failures to achieve or maintain erections.

Redefining the Prevalence of ED and Its Psychological Effects. On its Web site, Pfizer states that “in fact, more than half of all men over 40 have difficulties getting or maintaining an erection” ( http://www.viagra.com/ed/index.asp).

The Web site does not give a reference to support this statement.

One possible source of support for this statement is the Massachusetts Male Aging Study (MMAS), a community-based, random sample observational survey of men aged 40 to 70 years old conducted from 1987 to 1989 in cities and towns near Boston, Massachusetts [ 2].

The authors of the study extrapolated the results to argue that 52% of the entire male population in the United States between the ages of 40 and 70 suffer from ED.

The authors stated: “In the MMAS sample the prevalence of impotence of all degrees was estimated at 52%.

Projection of these results to 1990 population data would suggest that impotence affects 18 million American men 40 to 70 years old” [ 2].

However, the MMAS figures must be viewed with a number of caveats. First, there were actually two different groups of men in this study.

The first, and larger, group answered a series of nine questions about sexual activity. The second, and much smaller, group answered the same nine questions, plus an additional question to self-rate themselves as not impotent, minimally impotent, moderately impotent, or completely impotent. The answers to this final question by the men in the second group were then applied to the first group to derive the percent in the various classes of potency. The authors do not provide any information about whether the two groups were similar, and there are reasons to think that differences may exist between the groups.

The first group was randomly selected from towns and cities in the Boston Standard Metropolitan Statistical Area [ 3], while the

second

men

In the MMAS, 40% of 40-year-old men had ED, including 17% who were only minimally impotent, whereas 67% of 70 year olds were impotent.

Moreover, not all studies are in agreement with these figures.

Analysis of data from the US National Health and Social Life Survey indicates that among men 50–59 years old, 18% complained of trouble achieving or maintaining an erection during the past year [ 4].

A survey in the Netherlands found that only 1% of men 50–65 years of age had a complete inability to achieve an erection, and it was only in men aged 70–78 years that the rate of ED was similar to that in the MMAS [ 5]. Out of 13 studies on the prevalence of ED that were published until June 1998, the MMAS results were among the highest [ 1].

Thus, Pfizer's statement that “more than half of all men over 40 have difficulties getting or maintaining an erection” does not reflect the large variation in the prevalence of ED found in different studies. The MMAS found a strong association between ED and psychological factors, including “depression, low levels of dominance, and anger either expressed outward or directed inward.” The authors suggested that psychological symptoms might be a cause of ED, but these symptoms could also be an effect of ED (they wrote that “a man who has experienced a recent pattern of ED may be expected to be anxious, depressed and lacking

self-esteem

While not to deny that

there

In the Dutch study previously mentioned, only one-third of all discount priced viagra men and only 20% of men over the age of 70 with significant ED had major psychological concerns.

Furthermore, in sexually active men, 17%–28% had no normal erections, indicating that full erectile function is not essential for sildenafil 150 mg online sexual functioning [ 5].

Only 20% of Japanese men 40 to 79 years of age reported more than little worry and concern about sexual functioning, suggesting that perceptions of elderly male sexual function and its impact on health-related quality of life may differ among cultures and ethnic groups with differing values [ 6]. On its Web site, Pfizer states: “VIAGRA can work for you.

In fact, studies show that VIAGRA works for more than 80% of men with ED taking VIAGRA 100 mg versus 24% of men taking a sugar pill” ( http://www.viagra.com/whyViagra/highlyEffective.asp). The 80% success rate that Pfizer quotes for Viagra is important, though not critical, to being able to promote its use to a wide variety of men.

But that number is qualified on the Pfizer Web site as the number who experience improved erections ( http://www.viagra.com/consumer/aboutViagra/index.asp).

It is open to speculation whether the goal of most men is improved erections, or successful intercourse and the achievement of an orgasm. In most studies on Viagra, a 50%–60% rate of successful intercourse is recorded (in the dose titration studies reviewed in [ 1] for patients taking placebo, up to 25% of attempts at intercourse were successful compared with 50%–60% for patients taking Viagra 25–100 mg). This 50%–60% rate is far short of the “more than 80% of men” that Pfizer trumpets.

To make Viagra into a lifestyle drug, Pfizer needs to convince men that it is the first choice for therapy for any degree of ED, whatever the genesis of the problem. However, drug therapy may not always be the most appropriate treatment option.

The National Health and Social Life Survey data indicate that emotional and stress-related problems such as a deteriorating social and economic position generate elevated risk of experiencing sexual difficulties. In these cases, Viagra may be less important than counseling or help in finding a new job.

These possibilities are never mentioned on the Viagra Web site. Here is a sample of the questions and answers on the “About ED” portion of the Web site: Question: “I don't have ED because the problem doesn't happen often.

Does this mean that VIAGRA is not for me?” Answer: “Even if erection problems happen only once in a while, VIAGRA can help. You should know that most men with ED only experience problems some of the time.

In one study, VIAGRA helped 87% of men with mild-to-moderate ED have better erections versus 36% of men taking a sugar pill” ( http://www.viagra.com/faqs/faqs2.asp).

In case the message is missed, there is a couple on the Web page where the man looks to be in his mid-to-late 30s.

Pfizer reinforces its message with direct-to-consumer magazine ads, such as one featuring a virile looking man around 40 saying, “A lot of guys have occasional erection problems.

I chose not to accept mine and asked about Viagra.” Drug companies have identified lifestyle drugs as a “growth market.” The initial television ads in the US for Viagra used an aging Bob Dole (born 1923) as a spokesman, a 1996 Republican presidential candidate.

Since then, Pfizer has refocused its advertising campaign to match the lifestyle message on its Web site.

There is now advertising of Viagra at NASCAR races, and Pfizer hired 39-year-old Rafael Palmeiro, a former Texas Ranger baseball player as a spokesman ( Figure 1 ) [ 7]. Pfizer teamed up with Sports Illustrated magazine to create the Sportsman of the Year Trivia Game ( http://www.viagra.com/sports/index.asp). Between 1999 and 2001, Pfizer spent over US$303 million in direct-to-consumer advertising to get its message about Viagra to men [ 8–10].

Besides the large promotion budget, Pfizer has also paid a number of doctors to act as “consultants,” delivering public lectures and appearing in the mass media to expound on ED and Viagra [ 11] Pfizer denies that it is targeting younger men or that it is positioning Viagra as a lifestyle drug. Mariann Caprino, a spokeswoman for the company, is quoted in the New York Times as saying, “Have we gone out and given our advertising agency instructions to speak to this young population?

But the message from the pictures on the Web site, in magazine ads,

and

Between 1998 and 2002 the group showing the largest increase in Viagra use was men between the ages of 18 and 45, and only one-third of these men had a possible etiologic reason for needing Viagra [ 12]. Economic and Social Implications of the Expanding Market for Lifestyle Drugs.

Drug companies have identified lifestyle drugs as a “growth market.” The problems that they are designed to treat are easily self-diagnosed—we can all see if we are bald or fat—and as the baby boomers age, the population looking to these drugs will continue to grow.

Drug companies, driven by profit, go where the money is. Because of the potential size of the market for Viagra, paying for it in unlimited quantities will be very expensive.

If we believe the prophets of technology, soon there will be drugs for memory enhancement and

the

In one corner is the view of health as freedom from disease, where “the central purpose of health care is to maintain, restore, or compensate for the restricted opportunity and loss of function caused by disease and disability” [ 13]. In this model, a just medical system would not cover treatments and interventions that aim to enhance abilities not affected by disease and disability.

Opposing this is an expansionist definition, such as the one offered by the World Health Organization, where health is “a state of complete physical, mental and social well-being” ( http://www.who.int/about/definition/en/print.html). If we accept this view, then are we not obliged to provide for people who want to enhance themselves so that they can achieve mental and social well-being?

This debate is further complicated because there is not an equal balance in how we look at the options of accepting limitations and seeking enhancement. In a market-driven world, the money is in promoting enhancements, not in accepting limitations.

The ad featuring the man who chooses not to accept even occasional erection problems is one

example

Early on, Kaiser Permanente refused to cover Viagra for its 9 million members because of costs expected to be in the range of US$100 million per year [ 11]. According to one interpretation, reactions from insurers such as Kaiser Permanente were the reason that Pfizer put in place a US$35 million campaign to change insurers' decisions [ 11].

Another goal of Pfizer's campaign was to make ED an acceptable topic for public discourse, in order to remove the stigma attached to it and increase the possibility that third parties would provide coverage. Viagra presents a microcosm of the debate surrounding drugs that enhance lifestyle choices. The drug is effective and safe for people with medical problems warranting treatment, but it also can be used by a much wider population.

The company that manufactures the drug, recognizing that the potential market is huge, has aggressively targeted that much larger community.

Pfizer's well-financed campaign was aimed at raising awareness of the problem of ED, while at the same time narrowing the treatment possibilities to just a single option: medication.

Having succeeded in turning Viagra into a consumer product, Pfizer then turned its attention to payers in order to reap the benefits of the expanded market. Ultimately, there must be a debate about how limited resources for health care should be spent and who should make those decisions. Are men who seek to enhance their normal sexual function “worthy” enough to have their treatment paid for? If we pay for drugs and other procedures that enhance lifestyles, then other treatments either may not get funded at all or may become inadequately funded.

As the number of enhancement treatments grows, the scenario surrounding Viagra will become all too familiar with other drugs. Now is the time to start preparing for how we will deal

with

Erectile dysfunction (ED) is one of the most common conditions affecting middle-aged and older men. Nearly every primary care physician, internist and geriatrician will be called upon to manage this condition or to make referrals to urologists, endocrinologists and cardiologists who will assist in the treatment of ED.

This article will briefly discuss the diagnosis and management of ED. In addition, emerging concepts in ED management will be discussed, such as the use of testosterone to treat ED, the role of the endothelium in men with ED and treating the partner of the man with ED.

Finally, future potential therapies for ED will be discussed. erectile dysfunction endothelial dysfunction testosterone testosterone deficiency androgen deficiency testosterone replacement cardiovascular disease stem cells gene therapy.

erectile dysfunction endothelial dysfunction testosterone testosterone deficiency androgen deficiency testosterone replacement cardiovascular disease stem cells gene therapy. Nearly every primary care physician, internist and geriatrician now understand that many older men retain an interest in sexual activity as they age.

Some primary care physicians think that sexual potency in older men is the norm, and that if it is lacking, it is ‘all in the head.’ This viewpoint has not been supported by current literature. The Massachusetts Male Aging Study (MMAS) found that 52% of men between 40 and 70 years old reported having some form of erectile dysfunction (ED).1 The reality is that ED is a natural part of ageing and that the prevalence increases with age.

In the MMAS, they found that roughly 50% of men at 50 years old, 60% of men at 60 years old and 70% of men at 70 years old had ED. Thus, nearly all men who live long enough should develop ED.

The myths that surround the problems of impotence or ED confound the attempts of patients to receive treatment and the attempts of physicians to help them.1.

Many factors can contribute to sexual dysfunction in older men, including physical and psychological conditions, comorbidities and the medications used to treat them.

Aspects of an ageing man’s lifestyle and behaviour and androgen deficiency, most often decreasing testosterone levels, may affect sexual function as well. A study of men between the ages of 30 and 79 years showed that 24% had testosterone levels below 300 ng/dL and 5.6% had symptomatic androgen deficiency.2.

The percentage of men who engage in some form of sexual activity decreases from 73% for men aged 57–64 years to 26% for men aged 75–85 years.3 For some men, this constitutes a problem, but for others it does not.

The aetiology for this decline in sexual activity is multifactorial and is in part due to the fact that most of the female partners undergo menopause at 52 years of age with a significant decline in their libido and desire to engage in sexual activity. A study by Lindau and colleagues3 that examined sexuality in older Americans showed that 50% of the men in a probability sample of more than 3000 US adults reported at least one bothersome sexual problem and 33% had at least two such problems.3 This article will review

the

later

1600

In 1973, Dr Brantley Scott from Baylor College of Medicine reported on the implantable inflatable prosthesis that urologists still use today.5.

The major breakthrough occurred in 1998 when sildenafil became the first oral drug to be approved to treat ED.4 This was followed by

the

This is also true of the endocrine system, specifically the levels of testosterone production from the Leydig cells of the testicle. Accompanying the decrease in testosterone is a decrease in erections which also has cheap viagra near me a component in decrease in the blood supply to the penis making erection not as frequent and not as rigid compared with a young man’s erectile function.

Although these changes are in

itself

Other types of sexual dysfunction such as premature ejaculation and low libido may occur; however, the most common and disruptive problem in men is ED. Although most men will experience periodic episodes of ED, these episodes tend to become more frequent with advancing age. Medical conditions, such as hypertension, diabetes mellitus, and cardiovascular disease (CVD), and psychological conditions, such as depression and anxiety, also contribute to sexual dysfunction in middle-aged or elderly men. CVD and hypertension cause a narrowing and hardening of the arteries, leading to reduced blood flow to the corporal bodies, which is essential for achieving an erection. Diabetes is a common aetiology of sexual dysfunction, because it can affect both the blood vessels and the nerves that supply the penis.

Men with diabetes are four times more likely to experience ED, and on average, experience ED 15 years earlier than men without diabetes.7 Obesity is also correlated to the development of several types of dysfunction, including a decrease viagra no prescription usa in sex drive and an increase in episodes of ED.8.

There are hundreds of medications that have the side effect of ED and/or decreased libido.

Examples of drugs implicated as a cause of ED include hydrochlorothiazides and beta-blocking agents.

Medications used to treat depression, particularly the SSRIs such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Prozac Weekly, Sarafem), fluvoxamine (Luvox, Luvox CR), paroxetine (Paxil, Paxil CR, Pexeva) and sertraline (Zoloft), may also contribute to ED.9 Bupropion (Wellbutrin) which has a predominant effect on blocking the reuptake of dopamine is an antidepressant with lower incidence of ED.10 The side effects of 5ARIs occurring in fewer than 5% of patients can include gynaecomastia, ED, loss of libido and ejaculatory dysfunction.11.

Men being treated for prostate cancer with treatments such as radical prostatectomy, radiation therapy or the use of Lutenizing hormone-releasing hormone (LHRH) agonists and antagonists can expect that ED may accompany these treatments.12.

Smoking, excessive use of alcohol and illicit drugs are also associated with ED.13 A study in 2005 suggests that ED is not only more likely among men who smoked compared with those who never did, but that in younger men with ED, cigarette smoking is very likely the cause of their impotence.14 15.